Literature Collection

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based process healthcare personnel use to screen, manage, and triage patients struggling with substance use. The process requires clinic staff to furnish patients with structured screening questions. Providers can then offer treatment and mental health referral when indicated. Our team recently deployed a digital tablet-based version of the SBIRT screening questions in primary care. However, we needed to assess patient-reported usability of our approach because negative perceptions could limit clinic adoption, patient completion of the process, and effective referral. We, therefore, conducted a usability evaluation of our digital SBIRT screening instrument using a cross-sectional patient survey. Most participants (64.2%) reported completing the screening questions in under five minutes, with no reports of completion times exceeding fifteen minutes. Our results suggest the tablet-based SBIRT screener is easy to understand and can be efficiently completed before a clinical encounter. Furthermore, patients believed the digital SBIRT screener increases clinician awareness of patient health issues and promotes positive action. These findings support the continued use, wider adoption, and integration of digital SBIRT tools in clinical settings.

OBJECTIVE: This study assessed the utility and effectiveness of the new general health integration (GHI) framework among community behavioral health organizations designated as certified community behavioral health clinics (CCBHCs) or in the process of applying to become a CCBHC. METHODS: Nineteen licensed community behavioral health clinics, 18 of which had CCBHC status, participated in a 12-month learning collaborative. They used the GHI framework to assess their integration stage for 15 subdomains within eight domains of evidence-based practice. The clinics worked to improve their GHI practices with the support of monthly learning collaborative webinars, individual consultation calls, and technical assistance sessions. Clinics reported on performance quality metrics aligned with national CCBHC standards. Outcome measures included GHI framework scores at baseline and 1-year follow-up, capacity to report quality metrics at baseline and at the end of the collaborative, and average performance on the quality metrics at baseline versus at the end of the collaborative. RESULTS: Clinics showed overall improvement in integration stage over the study period. Of note, higher baseline GHI framework scores demonstrated a significant association with greater-quality performance at baseline (r=0.577, p=0.024) and follow-up (r=0.782, p=0.001). Capacity to track and report quality metrics increased significantly during the learning collaborative, as did average performance on quality metrics. CONCLUSIONS: Community behavioral health clinics using the GHI framework were able to advance their GHI practices with a 12-month learning collaborative project. The framework has the potential to serve as a useful tool for clinics aiming to enhance GHI practices.

OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness (compared with usual care) of a collaborative care model to treat community mental health center (CMHC) patients with psychosis and poorly controlled diabetes. METHODS: Stakeholder input was used to adapt a primary care-based collaborative care intervention for CMHC settings. Thirty-five adult CMHC clients with type II diabetes and hemoglobin A1c (HbA1c) >8% or blood pressure >140/90 were randomized to receive either collaborative care or usual care. Change in HbA1c was evaluated between baseline and three months. Paired t tests were used for within-group comparisons. RESULTS: After three months, intervention participants had a statistically significant mean decrease in HbA1c of 1.1% (p=.049). There was no significant change in HbA1c in the usual-care group. CONCLUSIONS: This pilot demonstrates the feasibility and acceptability of implementing collaborative care in CMHC settings and its preliminary effectiveness in improving glycemic control in a high-risk population.